Organization
LAFOURCHE ARC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICKY BONVILLAIN (FISCAL SERVICES DIRECTOR)
(985) 447-6214
Entity
Organization
Contact information
Practice address
100 W MAIN ST, THIBODAUX, LA 70301-5216
(985) 447-6214
(985) 447-4813
Mailing address
100 W MAIN ST, THIBODAUX, LA 70301-5216
(985) 447-6214
(985) 447-4813
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
6791
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1436810
—
LA
Enumeration date
01/17/2007
Last updated
08/22/2020
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